Data Visualization flexdashboard | Abigail Burns, Sharon Jepkosgei, Chizoma Oparaji, Jannelle Marie Navales

Storytelling with Data

Prescription Drug Pricing in the United States: Analyzing the Concrete and Abstract

Abigail Burns, Sharon Jepkosgei, Chizoma Oparaji, Jannelle Marie Navales

Introduction

Purpose

This project illustrates public spending on prescription drugs and the effect of regulatory legislation over time.

Background

  • More than 131 Million people (66% of adults) in the US use prescription drugs

  • Prescription drugs are vital to maintain/improve health

  • The rising cost of prescription drugs = overburdened public healthcare systems and individual family budgets across the country

  • Affordability & accessibility is vital

Research Question

Do prescription drug policies and regulations have a direct impact on the affordability and accessibility of prescriptions over time?

Research Hypothesis (H1)

Prescription drug policies and regulations have had a measurable impact on affordability and accessibility of prescriptions.

Philosophy

  • More like Wickham’s approach (not Tufte’s simplicity)

  • Layered Approach - Building visualizations through layers (adding scales and aesthetics)

  • Customization - Customize visualizations extensively, allowing for fine-tuned control over every aspect of a chart.

  • Interesting and easily interpreted visualizations.

Statins

  • The prices of popular statins (medicines which lower blood cholesterol levels) have been on the rise in the past decade

  • Biggest increase between 2016 and 2018, which was a period of high economic growth

Inhalers

  • The prices of popular antianaphylactics (medicines which treat and prevent allergic reactions) peaked between 2018-2019

Insulin

Rising Prices

  • Over the past two decades, pharmaceutical manufacturers have increased list prices on insulin each year
  • Over 9 million Americans rely on insulin, and they have been raising red flags over soaring prices for years

Trend

  • The average cash price per insulin unit rose 54% from Jan. 2014 to April 2019

  • Dosage price then dropped 10.6% from Jan. 2020 to July 2023, a period of economic decline

Diabetic Prescription Usage Over Time

High costs, High risks

  • There was a drop in diabetes medication use in 2018 which has not since recovered

  • The high cost of insulin forced many people to ration their usage

  • People in the U.S. either skip, delay or use less insulin than is needed on a daily basis throughout the year

  • Insulin rationing can have dire health consequences

Comparing Price with Other Developed Countries: 2018

Analysis

  • We found a possible explanation for the drop in insulin usage in 2018.

  • According to the chart, in 2018, the average list price for one vial of insulin in the U.S. was $98.70

  • This dosage price is up to 10x more than other countries in the OECD

Why is this important?

  • People with Type 1 diabetes need on average 1 to 3 vials of insulin per month 

  • Patients with Type 2 diabetes don’t always need to take insulin, but those who do can sometimes require more than those with Type 1

Insulin Regulation

Inflation Reduction Act (IRA): Effect on Manufacturers

  • Went into effect in January 2023

  • Patients who are covered under the Medicare Part D plan now have a $35 out-of-pocket monthly cap for their insulin

  • Higher rebates, even exceeding 100% of a drug’s price, in cases when manufacturers have raised list prices sharply over time triggering large best price discounts

    Under the IRA, manufacturers will face penalties in Medicare for raising list prices faster than inflation

Impact of Legislation: Consumers

The map shows the estimated out-of-pocket savings by state if the IRA had been in effect in 2020

  • Webscraped data from USDHHS report

  • Total savings to beneficiaries: $734 million in Part D and $27 million$27 million in Part B

  • Average yearly savings of approximately $500 for Medicare beneficiaries

  • States with the most people on Medicare projected to benefit from the new IRA insulin cost savings:

    - Texas 114,000 beneficiaries

    - California 108,000

    - Florida 90,000

  • Highest average annual out-of-pocket savings:

    - North Dakota $805

    - Iowa $725

    - South Dakota $725

Impact of Legislation: Corporations

[1] "LLY"

Impact of regulation

  • Facing pressure to curb diabetes-treatment costs, Eli Lilly & Co. announced on March 1 that it is slashing insulin prices

  • They immediately capped the out-of-pocket cost of all of its insulin at $35 a month

  • The graph shows Eli Lilly & Co. stock prices from June 2022 to most recent data

  • From the graph reduction in insulin price has not affected the bottom line of Eli Lilly & Co.

Future impact

  • IRA only applies to those with Medicare

  • But, medicare is the largest single purchaser of prescription drugs in the US

  • This might further deter drug makers from increasing prices each year while offering greater rebates to insurers

Impact of Legislation: Corporations

[1] "NVO"

  • Novo Nordisk and Sanofi are other dominant insulin manufacturers that announced they have drastically lowered list prices and out-of-pocket costs in March 2023.

  • Novo Nordisk stock prices have an upward trend

Impact of Insurance

The graph shows how affordability of prescription medication varies by insurance, coverage type, and income.

  • Affordability problems increase as income falls and are much higher among those without insurance coverage

  • People with diabetes enrolled in high-deductible plans report greater affordability problems than those in conventional private insurance plans

Affordability

The Affordable Care Act (ACA)

  • Prices increased rapidly between 2007 and 2017

  • But, coverage expansions reduced the share of those with diabetes in each income group who reported difficulty affording prescription drugs.

  • The greatest declines have been among people with incomes between 100 percent and 300 percent of the federal poverty level

Takeaways

Case for Medicaid expansion

Our analysis suggests that the most important factors affecting the affordability of insulin are:

  • the availability of coverage

  • the form of that coverage

People with adequate coverage are often shielded from these price increases.

Medicaid also provides patients with diabetes and other diseases

  • more predictable out-of-pocket expenses

  • better access to regular care